小肠移植术后慢性移植物失功1例报道及文献复习

目的探讨小肠移植术后慢性移植物失功(chronic graft dysfunction,CGD)的诊断及治疗。方法报道国内首例同种异体小肠移植患者术后CGD的临床资料,复习相关文献。结果患者因"门静脉血栓、脾静脉血栓致肠系膜血栓"切除了大部分小肠,后行同种异体小肠移植术。术后长期服用他克莫司(FK506),屡次发生排斥反应。术后3次因"小肠狭窄、不全性肠梗阻"行"小肠节段切除吻合术"。其中术后576d第3次出现肠梗阻,予经皮内镜下胃空肠造瘘术胃肠减压等治疗,确定移植肠不可逆性失功后行移植小肠切除术。结论 CGD治疗困难,预后不佳,预防胜于治疗。在确诊CGD不可逆后应尽快切除移植小肠,挽救患者生命,有条件应尽快安排再次移植。

Chronic graft dysfunction after intestinal transplantation: a case report and literature review

Objective To investigate diagnosis and treatment of chronic graft dysfunction(CGD) after intestinal transplantation.Methods Clinical data of the first case of CGD after intestinal transplantation in China were reported,and the related literatures were reviewed.Results One patient underwent allogeneic intestinal transplantation because of removal of most small intestine for mesenteric thrombosis by portal and splenic vein thrombosis.Tacrolimus(FK506) was taken after operation.But rejections happened several times.Small intestine segment resection and anastomosis were performed 3 times after transplantation for stenosis of small intestine and incomplete intestinal obstruction.The third intestinal obstruction occurred at post-transplant 576 d.The patient was treated by percutaneous endoscopic gastrostomy and jejunostomy for gastrointestinal decompression.The transplanted small intestine was resected after the irreversible graft dysfunction was diagnosed.Conclusions The treatment of CGD is difficult and the prognosis is poor.Prevention is more important than treatment.Small intestine graft should be cut off to save patients’ lives once CGD is diagnosed irreversible.Retransplantation should be arranged as soon as possible in this condition.